Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Dengue fever is a significant cause of febrile illness in international travelers.
• Dengue symptoms mimic other infections, often delaying prompt diagnosis.
• Timely diagnosis is crucial for effective patient management and preventing severe outcomes.

Purpose of the Study:

• To analyze diagnostic delays and missed opportunities in dengue fever cases in the United States.
• To identify factors contributing to delayed dengue diagnosis among patients.
• To estimate the frequency and duration of missed diagnostic opportunities.

Main Methods:

• Retrospective cohort study using Merative MarketScan Research databases (2001-2021).
• Identified 5,992 dengue cases, comparing pre-diagnosis symptom presentation frequency.
• Utilized bootstrap analysis to estimate diagnostic delay duration and risk factors.

Main Results:

• Over half (51.6%) of dengue patients had pre-diagnosis visits with characteristic symptoms.
• An estimated 22.8% of patients experienced at least one missed diagnostic opportunity.
• Average diagnostic delay was 4.02 days; delays were more common during weekends and with antibiotic/opioid prescriptions.

Conclusions:

• Diagnostic delays for dengue are common, with significant potential for missed opportunities.
• Weekend visits and certain prescriptions may increase the risk of delayed dengue diagnosis.
• Further research should focus on improving diagnostic timeliness and identifying at-risk populations.